{"id":35087,"date":"2014-09-04T17:48:39","date_gmt":"2014-09-04T12:18:39","guid":{"rendered":"https:\/\/www.legalindia.in\/news\/?p=35087"},"modified":"2014-09-04T17:48:39","modified_gmt":"2014-09-04T12:18:39","slug":"firm-pay-rs-92-k-repudiating-mediclaim-arbitrarily","status":"publish","type":"post","link":"https:\/\/www.legalindia.com\/news\/firm-pay-rs-92-k-repudiating-mediclaim-arbitrarily","title":{"rendered":"Firm to pay over Rs 92 K for repudiating mediclaim arbitrarily"},"content":{"rendered":"<p><span style=\"font: 14px\/22px Tahoma, Arial, Georgia; color: #000000; text-transform: none; text-indent: 0px; letter-spacing: normal; word-spacing: 0px; float: none; display: inline !important; white-space: normal; background-color: #ffffff; -webkit-text-stroke-width: 0px;\">A consumer forum here has asked an<span class=\"Apple-converted-space\">\u00a0<\/span><\/span><a class=\"storyTags\" style=\"font: 14px\/22px Tahoma, Arial, Georgia; margin: 0px; padding: 0px; border: 0px currentColor; color: #0000ff !important; text-transform: none; text-indent: 0px; letter-spacing: normal; text-decoration: none; word-spacing: 0px; white-space: normal; cursor: pointer; background-color: #ffffff; -webkit-text-stroke-width: 0px;\" href=\"https:\/\/www.business-standard.com\/search?type=news&amp;q=Insurance\" target=\"_blank\">insurance<span class=\"Apple-converted-space\">\u00a0<\/span><\/a><span style=\"font: 14px\/22px Tahoma, Arial, Georgia; color: #000000; text-transform: none; text-indent: 0px; letter-spacing: normal; word-spacing: 0px; float: none; display: inline !important; white-space: normal; background-color: #ffffff; -webkit-text-stroke-width: 0px;\">firm to pay over Rs 92,000 to a man for repudiating medi claim for his son&#8217;s treatment, saying its action was arbitrary.<span class=\"Apple-converted-space\">\u00a0<\/span><\/span><br style=\"font: 14px\/22px Tahoma, Arial, Georgia; color: #000000; text-transform: none; text-indent: 0px; letter-spacing: normal; word-spacing: 0px; white-space: normal; background-color: #ffffff; -webkit-text-stroke-width: 0px;\" \/><br style=\"font: 14px\/22px Tahoma, Arial, Georgia; color: #000000; text-transform: none; text-indent: 0px; letter-spacing: normal; word-spacing: 0px; white-space: normal; background-color: #ffffff; -webkit-text-stroke-width: 0px;\" \/><span style=\"font: 14px\/22px Tahoma, Arial, Georgia; color: #000000; text-transform: none; text-indent: 0px; letter-spacing: normal; word-spacing: 0px; float: none; display: inline !important; white-space: normal; background-color: #ffffff; -webkit-text-stroke-width: 0px;\">New<span class=\"Apple-converted-space\">\u00a0<\/span><\/span><a class=\"storyTags\" style=\"font: 14px\/22px Tahoma, Arial, Georgia; margin: 0px; padding: 0px; border: 0px currentColor; color: #0000ff !important; text-transform: none; text-indent: 0px; letter-spacing: normal; text-decoration: none; word-spacing: 0px; white-space: normal; cursor: pointer; background-color: #ffffff; -webkit-text-stroke-width: 0px;\" href=\"https:\/\/www.business-standard.com\/search?type=news&amp;q=Delhi\" target=\"_blank\">Delhi<span class=\"Apple-converted-space\">\u00a0<\/span><\/a><span style=\"font: 14px\/22px Tahoma, Arial, Georgia; color: #000000; text-transform: none; text-indent: 0px; letter-spacing: normal; word-spacing: 0px; float: none; display: inline !important; white-space: normal; background-color: #ffffff; -webkit-text-stroke-width: 0px;\">Consumer Disputes Redressal Forum, presided by C K Chaturvedi, asked the Oriental Insurance Company Ltd to pay Rs 92,696 to Delhi resident Sachin Tayal, who had sought medical after his his minor child was admitted at a hospital here for removal of adenoids (enlarged lymphatic tissue) on January 31, 2011.<span class=\"Apple-converted-space\">\u00a0<\/span><\/span><br style=\"font: 14px\/22px Tahoma, Arial, Georgia; color: #000000; text-transform: none; text-indent: 0px; letter-spacing: normal; word-spacing: 0px; white-space: normal; background-color: #ffffff; -webkit-text-stroke-width: 0px;\" \/><br style=\"font: 14px\/22px Tahoma, Arial, Georgia; color: #000000; text-transform: none; text-indent: 0px; letter-spacing: normal; word-spacing: 0px; white-space: normal; background-color: #ffffff; -webkit-text-stroke-width: 0px;\" \/><span style=\"font: 14px\/22px Tahoma, Arial, Georgia; color: #000000; text-transform: none; text-indent: 0px; letter-spacing: normal; word-spacing: 0px; float: none; display: inline !important; white-space: normal; background-color: #ffffff; -webkit-text-stroke-width: 0px;\">The company, however, turned down the claim on the ground that as per policy congenital defects are excluded, and that complaint of snoring, fever and difficulty in hearing were pre-existing diseases.<span class=\"Apple-converted-space\">\u00a0<\/span><\/span><br style=\"font: 14px\/22px Tahoma, Arial, Georgia; color: #000000; text-transform: none; text-indent: 0px; letter-spacing: normal; word-spacing: 0px; white-space: normal; background-color: #ffffff; -webkit-text-stroke-width: 0px;\" \/><br style=\"font: 14px\/22px Tahoma, Arial, Georgia; color: #000000; text-transform: none; text-indent: 0px; letter-spacing: normal; word-spacing: 0px; white-space: normal; background-color: #ffffff; -webkit-text-stroke-width: 0px;\" \/><span style=\"font: 14px\/22px Tahoma, Arial, Georgia; color: #000000; text-transform: none; text-indent: 0px; letter-spacing: normal; word-spacing: 0px; float: none; display: inline !important; white-space: normal; background-color: #ffffff; -webkit-text-stroke-width: 0px;\">In its order, the forum noted that the problem for which complainant&#8217;s son was admitted in the hospital was not a disease but medical condition.<span class=\"Apple-converted-space\">\u00a0<\/span><\/span><br style=\"font: 14px\/22px Tahoma, Arial, Georgia; color: #000000; text-transform: none; text-indent: 0px; letter-spacing: normal; word-spacing: 0px; white-space: normal; background-color: #ffffff; -webkit-text-stroke-width: 0px;\" \/><br style=\"font: 14px\/22px Tahoma, Arial, Georgia; color: #000000; text-transform: none; text-indent: 0px; letter-spacing: normal; word-spacing: 0px; white-space: normal; background-color: #ffffff; -webkit-text-stroke-width: 0px;\" \/><span style=\"font: 14px\/22px Tahoma, Arial, Georgia; color: #000000; text-transform: none; text-indent: 0px; letter-spacing: normal; word-spacing: 0px; float: none; display: inline !important; white-space: normal; background-color: #ffffff; -webkit-text-stroke-width: 0px;\">&#8220;&#8230;The adenoids in children is a common phenomena leading to fever, difficulty in hearing as ear, nose, throat are interconnected, and the treatment is only removal of growth of soft tissues in throat and insertion of grommets in ears. These are not diseases but medical condition. In no case it can be called congenital disease,&#8221; it said.<span class=\"Apple-converted-space\">\u00a0<\/span><\/span><br style=\"font: 14px\/22px Tahoma, Arial, Georgia; color: #000000; text-transform: none; text-indent: 0px; letter-spacing: normal; word-spacing: 0px; white-space: normal; background-color: #ffffff; -webkit-text-stroke-width: 0px;\" \/><br style=\"font: 14px\/22px Tahoma, Arial, Georgia; color: #000000; text-transform: none; text-indent: 0px; letter-spacing: normal; word-spacing: 0px; white-space: normal; background-color: #ffffff; -webkit-text-stroke-width: 0px;\" \/><span style=\"font: 14px\/22px Tahoma, Arial, Georgia; color: #000000; text-transform: none; text-indent: 0px; letter-spacing: normal; word-spacing: 0px; float: none; display: inline !important; white-space: normal; background-color: #ffffff; -webkit-text-stroke-width: 0px;\">&#8220;&#8230;We find that Opposite Party (company) has not applied its mind and arbitrarily repudiated a just claim,&#8221; the forum&#8217;s bench, also comprising its members S R Chaudhary and Ritu Garodia, said.<span class=\"Apple-converted-space\">\u00a0<\/span><\/span><br style=\"font: 14px\/22px Tahoma, Arial, Georgia; color: #000000; text-transform: none; text-indent: 0px; letter-spacing: normal; word-spacing: 0px; white-space: normal; background-color: #ffffff; -webkit-text-stroke-width: 0px;\" \/><br style=\"font: 14px\/22px Tahoma, Arial, Georgia; color: #000000; text-transform: none; text-indent: 0px; letter-spacing: normal; word-spacing: 0px; white-space: normal; background-color: #ffffff; -webkit-text-stroke-width: 0px;\" \/><span style=\"font: 14px\/22px Tahoma, Arial, Georgia; color: #000000; text-transform: none; text-indent: 0px; letter-spacing: normal; word-spacing: 0px; float: none; display: inline !important; white-space: normal; background-color: #ffffff; -webkit-text-stroke-width: 0px;\">The forum held the company guilty of deficiency in service. It directed the firm to pay the claim amount of Rs 47,696, besides Rs 25,000 for deficiency, harassment and mental agony and Rs 20,000 for the litigation<span class=\"Apple-converted-space\">\u00a0<\/span><\/span><br style=\"font: 14px\/22px Tahoma, Arial, Georgia; color: #000000; text-transform: none; text-indent: 0px; letter-spacing: normal; word-spacing: 0px; white-space: normal; background-color: #ffffff; -webkit-text-stroke-width: 0px;\" \/><br style=\"font: 14px\/22px Tahoma, Arial, Georgia; color: #000000; text-transform: none; text-indent: 0px; letter-spacing: normal; word-spacing: 0px; white-space: normal; background-color: #ffffff; -webkit-text-stroke-width: 0px;\" \/><span style=\"font: 14px\/22px Tahoma, Arial, Georgia; color: #000000; text-transform: none; text-indent: 0px; letter-spacing: normal; word-spacing: 0px; float: none; display: inline !important; white-space: normal; background-color: #ffffff; -webkit-text-stroke-width: 0px;\">Tayal had told the forum that he, along with his son, was insured under Medi claim policy of the company since September 26, 2007.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>A consumer forum here has asked an\u00a0insurance\u00a0firm to pay over Rs 92,000 to a man for repudiating medi claim for his son&#8217;s treatment, saying its action was arbitrary.\u00a0New\u00a0Delhi\u00a0Consumer Disputes Redressal Forum, presided by C K Chaturvedi, asked the Oriental Insurance Company Ltd to pay Rs 92,696 to Delhi resident Sachin Tayal, who had sought medical [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":34772,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[86],"tags":[29671],"class_list":["post-35087","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-consumer-law-news","tag-repudiating-mediclaim-arbitrarily"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Firm to pay over Rs 92 K for repudiating mediclaim arbitrarily - Legal News India - Supreme Court &amp; High Court Updates<\/title>\n<meta name=\"description\" content=\"A consumer forum here has asked an\u00a0insurance\u00a0firm to pay over Rs 92,000 to a man for repudiating medi claim for his son&#039;s treatment, saying its action was - Get the latest legal news from the Supreme Court, High Courts, and government. 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The New Delhi District Consumer Disputes Redressal Forum observed that LIC had 'misdirected itself' by not showing\u2026","rel":"","context":"In &quot;Consumer Law News&quot;","block_context":{"text":"Consumer Law News","link":"https:\/\/www.legalindia.com\/news\/category\/consumer-law-news"},"img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":35733,"url":"https:\/\/www.legalindia.com\/news\/theft-claim-national-insurance-co-ltd-asked-pay-rs-5l","url_meta":{"origin":35087,"position":1},"title":"Theft claim: National Insurance Co Ltd asked to pay over Rs 5L","author":"Legal India Admin","date":"November 3, 2014","format":false,"excerpt":"National Insurance Co Ltd has been directed by a consumer forum here to pay over Rs 5 lakh to a businesswoman for \"arbitrarily\" repudiating a theft claim and also initiate disciplinary action against the incompetent officer who supported or approved such illegal action. 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Presiding member P N Kashalkar ordered the insurance company to pay this amount along with interest at the rate of 7\u2026","rel":"","context":"In &quot;Top Law News&quot;","block_context":{"text":"Top Law News","link":"https:\/\/www.legalindia.com\/news\/category\/top-law-news"},"img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":35427,"url":"https:\/\/www.legalindia.com\/news\/forum-denies-claim-due-delay-informing-insurance-firm","url_meta":{"origin":35087,"position":3},"title":"Forum denies claim due to delay in informing insurance firm","author":"Legal India Admin","date":"October 6, 2014","format":false,"excerpt":"A consumer forum here has denied medical insurance claim to a man, noting that the insurer was informed after a delay of five months about the injuries. , presided by Babu Lal, rejected Hisar resident Suresh Cander's mediclaim of Rs 48,795 filed against Oriental Insurance Company Ltd. The forum noted\u2026","rel":"","context":"In &quot;Consumer Law News&quot;","block_context":{"text":"Consumer Law News","link":"https:\/\/www.legalindia.com\/news\/category\/consumer-law-news"},"img":{"alt_text":"consumer forum","src":"https:\/\/i0.wp.com\/www.legalindia.in\/news\/wp-content\/uploads\/2014\/06\/consumer-forum.jpg?resize=350%2C200&ssl=1","width":350,"height":200},"classes":[]},{"id":33704,"url":"https:\/\/www.legalindia.com\/news\/hc-lets-govt-intervene-pil-mediclaim-policy","url_meta":{"origin":35087,"position":4},"title":"HC lets govt intervene in PIL on mediclaim  policy","author":"Legal India Admin","date":"June 13, 2014","format":false,"excerpt":"The Bombay High Court today allowed the Maharashtra government to intervene in a public interest litigation about the problems faced by Mediclaim policy holders. 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